Prenatal Care and Testing - Pregnancy

<html><head></head><body><h2>Fetal kick count and movements</h2>
Most women feel the baby's first movements after 18-20 weeks of the pregnancy. A baby or fetal kick count is among the most important observations to ensure the baby's health. It is among the most important observations to ensure the baby's health.
Check out our <a href="https://babymed.com/tools/baby-kick-count" target="_blank">interactive baby kick count tool!</a>
An active baby is usually a healthy baby and you usually feel your baby stretch, kick, roll and turn every day. Some babies are more active than others. All babies have periods of sleep during which they are not as active. You will get to know your baby’s pattern of movements and when your baby is most active.
<h2>Is a fetal kick count effective in reducing adverse outcomes?</h2>
In some studies, decreased fetal movement has been associated with poor pregnancy outcomes including <a title="stillbirth" href="http://www.babymed.com/after-stillbirth-take-your-time">stillbirth</a>, and about 50% of women with a stillbirth reported that they felt a gradual decrease of fetal movements before intrauterine death. This is why many women and doctors use a fetal movement count to assess the baby's well-being.
Recently, however, some studies have questioned whether decreased fetal movement can prevent poor perinatal outcome such as stillbirths.&nbsp;In a recent 2018 study in <a style="font-size: 0.9em;" href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31543-5/fulltext" target="_blank">The Lancet</a>&nbsp;the authors did not find a decrease in stillbirths with decreased fetal movements.
Maternal perception of decreased fetal movement has been reported in 15% of pregnancies during the third trimester and around 50% of women notice a gradual reduction of fetal movement days before intrauterine death.&nbsp;<a id="WhenFeelBabyKick" name="WhenFeelBabyKick"></a>
<h2>When will I feel my baby kick? </h2>
Most women will feel the baby's movements after 18-20 weeks of the pregnancy. You should feel movements throughout the day, each day from 24 weeks of the pregnancy until the baby is born. The fetal kick count is done usually after 24 weeks of the pregnancy to monitor the fetal health.

<h2>How to do a kick count</h2>
There are many different ways to do a kick count. Here is the "count-to-ten" method to do the Kick Count (<a title="Graph Fetal Kick Count" href="https://babymed.com/pregnancy/fetal-kick-count-movements">Download the graph here</a>):
<ul>
<li>Count fetal movements once a day, preferably at the same time every day and within 1 to 2 hours after a meal. Early evening after dinner is a good time because the fetus is usually more active then.</li>
<li>Get a sheet of paper and pen to indicate the movements.</li>
<li>Have a clock or watch nearby to observe the time passed.</li>
<li>Lie on your side while counting, preferably on your left side.</li>
<li>Mark down the start time.</li>
<li>Count any movement you feel - a roll, a kick, or a "swish" - except for the smallest flutters.</li>
<li>Count until you have felt ten fetal movements.</li>
<li>Ideally, you want to feel at least 10 movements within 2 hours.&nbsp;Most likely you will feel 10 movements in much less time</li>
<li>Mark down the finish time, and the total amount of time it took to count the ten movements.</li>
</ul>
Talk to your doctor or midwife about what you should do if there's a problem with your baby's movements. Many providers ask their patients to contact them or go to the labor and delivery unit if:
<ul>
<li>You don't feel your baby move all day.</li>
<li>It takes progressively longer from one day to the next to count four movements.</li>
<li>It takes more than an hour to count four movements.</li>
</ul>
You might want to start a notebook of your own or use a fetal kick chart to record the time you start, place a checkmark for the time of the 10th movement. This will help you observe patterns and discover how long it normally takes for your baby to move 10 times. Keep in mind that you are looking for significant deviations from the pattern.
<h2>What is the best time and position to do the kick count?</h2>
Try to schedule the kick count during your baby's most active time of day, but also when you will be able to record movements over three or four hours. You will need to record movements starting from about the same time each day.
You may want to have a meal or snack before starting as you probably have noticed, food often makes your baby active. Alternatively, try a few minutes of exercise or take a brisk walk. Some moms prefer sitting with a good backrest with their arms holding their belly. Other moms prefer lying on their left side, which they find most effective for monitoring their baby. Lying on your left side also allows for the best circulation which could lead to a more active baby. Be sure you have a clock in view, and note on the kick count chart what time you start to record movements.<a id="WhenCallPhysicianMidwife" name="WhenCallPhysicianMidwife"></a>

<h2>When should I call my physician or midwife?</h2>
Your doctor may ask you to count your baby’s movements once every day. Count your baby’s movements to be sure that you feel at least 10 (in Canada some say 6) movements in 2 hours. If you think there is a decrease in your baby’s movements this is an important sign that your baby may not be well.
If you haven't concentrated on counting the baby movements then it's possible you may have missed them. Focus on the baby movements and count your baby's movements, lie on your left side with support under your bump. Stay still for a couple of hours, during which time you should feel at least 10 separate movements.
You're more likely to be aware of your baby's movements when you're lying down rather than sitting, and you'll probably be least aware of them when you're standing.
Here are some quick ways to encourage your baby to move:
If your baby starts to move around, all is probably well. But keep an eye on his movements from now on, and seek help sooner rather than later if you have any concerns.
<ul>
<li>If you have followed the above recommendations and have not felt 10 kicks by the end of the second hour, wait a few hours and try again. If after trying a second time, you do not feel 10 movements within 2 hours you should contact your healthcare provider.</li>
<li>If you notice a significant deviation from the pattern over the course of 3 to 4 days.</li>
<li>Put your feet up, have a snack, and relax. Your baby may be rocked to sleep while you're moving around, in which case he may wake up when you stop and have something to eat.</li>
<li>Have a really cold drink. Your baby may feel the change in temperature and try to move away from it. A sugary cold drink may also give him a sugar boost to encourage movement. Make some noise. </li>
<li>Play loud music or slam a door to see if he responds.</li>
</ul>
<h2>How to manage reduced fetal movements?</h2>
There are several recommendations how to address decreased fetal movements after 28 weeks of the pregnancy. In addition to check for risk factors of stillbirth additional recommendations include:
<ul>
<li>Delivery if 39 weeks or more pregnant</li>
<li>Nonstress testing</li>
<li>Check a blood test for fetal-maternal hemorrhage (<a href="https://babymed.com/kleihauer-betke-test">Kleihauer-Betke test</a>)</li>
<li>Sonogram to make sure the fetus is not too small</li>
</ul>
<h2>Literature on reduced fetal movements and outcomes</h2>
A recent study in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31543-5/fulltext#seccestitle80" target="_blank">The Lancet </a>showed no reduction of stillbirth when women reported reduced fetal movements. However, the study did not mention how they defined "reduced fetal movements" making it difficult to interpret the findings. An <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31720-3/fulltext" target="_blank">editorial</a> claimed that encouraging&nbsp; awareness of reduced fetal movements may be harmful.&nbsp;“note that the advice to pregnant women in the study ‘was that they should monitor changes in movements from 24 weeks and that they should refer themselves immediately if they detected altered movement after 28 weeks.’” The editorialists observed, “With hindsight, the recommendation to encourage mothers to report changes from as early as 28 weeks might have been misguided.” They added, “Although overall deaths were not stratified by duration of gestation, it is plausible that limiting awareness campaigns to beyond 37 weeks would be safer.”

Yaffe H Daily fetal movement recording and fetal prognosis. Obstet Gynecol. 1973; 41: 845-850
Heazell AEP Budd J Li M et al. Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study. BMJ Open. 2018; 8: e020031&nbsp;
Stacey T Thompson JM Mitchell EA Ekeroma A Zuccollo J McCowan LM Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth study. Birth. 2011; 38: 311-316
Sovio U White IR Dacey A Pasupathy D Smith GCS Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet. 2015; 386: 2089-2097
Thornton JG Hornbuckle J Vail A Spiegelhalter DJ Levene M Infant wellbeing at 2 years of age in the Growth Restriction intervention Trial (GRIT): multicentred randomised controlled trial. Lancet. 2004; 364: 513-520
Mangesi L Hofmeyr GJ Smith V Smyth RM Fetal movement counting for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2015; 10 (CD004909.)
Grant A Valentin L Elbourne D Alexander S Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. Lancet. 1989; 2: 345-349
NHS England Saving Babies' Lives: a care bundle for reducing stillbirth. https://www.england.nhs.uk/wp-content/uploads/2016/03/saving-babies-lives-car-bundl.pdf
Tveit JV Saastad E Stray-Pedersen B et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines—a clinical quality improvement. BMC Pregnancy Childbirth. 2009; 9: 32
Norman JE Marlow N Messow CM et al. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet. 2016; 387: 2106-2116
Walker KF Bugg GJ Macpherson M et al. Randomized trial of labor induction in women 35 years of age or older. N Engl J Med. 2016; 374: 813-822
</body></html>

Most women feel the baby's or fetus' first movements after 18-20 weeks of the pregnancy. A baby or fetal kick count is among the most important observations to ensure the baby's health. 

Counting Fetal Movements: The Baby Kick Count

The <a href="/tools/bmi-calculator">body mass index (BMI) calculator</a> calculates your BMI and let's you know if your weight is normal or not. Calculating your BMI before and during pregnancy is especially important as extremes of BMI (too high or too low) may affect your fertility and increase pregnancy complications. The &nbsp;body mass index, or BMI, is a term that is new to most people. When compared to your weight in pounds (or kilograms) the BMI gives you a much better idea about your actual weight. The BMI is the measurement of choice for many physicians and researchers studying obesity. The BMI is calculated with a mathematical formula which takes into account not just a person's weight but also height. The BMI equals a person's weight in kilograms divided by height in meters squared. (BMI=kg/m2).
In May of 2009, the Institute of Medicine (IOM) issued guidelines on weight gain during pregnancy. Depending on how much a woman weighed before getting pregnant, the IOM recommended weight gain for each category of prepregnancy BMI is as follows:
<ul>
<li>Underweight (&lt; 18.5 kg/m2); total weight gain range: 28 to 40 pounds</li>
<li>Normal weight (18.5 - 24.9 kg/m2); total weight gain range: 25 to 35 pounds</li>
<li>Overweight (25.0 - 29.9 kg/m2); total weight gain range: 15 to 25 pounds</li>
<li>Obese (≥ 30.0 kg/m2); total weight gain range: 11 to 20 pounds</li>
</ul>
&nbsp;

Body mass index calculator. The BMI body mass calculator let's you know if your weight is normal or not. Calculating your BMI before and during pregnancy is especially important as extremes of BMI (too high or too low) may affect your fertility and increase pregnancy complications.

Body Mass Index Calculator Calcuates BMI

<h2>Could the hCG pregnancy hormone levels signify whether you may be having a boy or a girl?</h2>
According to a recent study, women who carried a female fetus had hCG levels significantly higher than women who carried a male fetus. This finding is consistent with that same conclusion identified by several other researchers.

In a study published by Yaron Y et al in Human Reproduction, the authors studied 1,325 pregnant women with singleton pregnancies at 10-13 weeks and compared different hormone levels including the <a href="/normal-hcg-blood-level-by-week-during-pregnancy" target="_self">pregnancy hormone human chorionic gonadotropin (hCG)</a>&nbsp;between women carrying a male and a female fetus.
These findings may have implications not only for <a href="/tools/down-syndrome-risk-calculator" target="_self">evaluating risks of Down syndrome</a> (women carrying female fetuses had a higher risk for Down syndrome) but also on the timing of a pregnancy test. If women carrying a male fetus have lower hCG levels then it may be possible that their first positive urine pregnancy test could be delayed.

hCG is an important hormone to keep an eye on during pregnancy.&nbsp;When it&nbsp;decreases early in pregnancy, it is clear that the&nbsp;pregnancy&nbsp;is not viable. However, after 10-11 weeks a decrease in hCG is not unusual in normal pregnancies. The management of cases with too low or decreasing hCG levels often consists of observation through blood testing and intervention when necessary.
It's worth noting that hCG changes from day to day so the timing of the blood matters. In general, hCG usually doubles every 48-72 hours very early in pregnancy and every 3-4 days later on until about 9-10 weeks of the pregnancy when it levels off. Consequently, there is no single <a href="/normal-hcg-blood-level-by-week-during-pregnancy" target="_self">"normal" hCG level during early pregnancy</a>. There are wide ranges of what constitutes normal levels so consulting your doctor on your specific situation is your best bet.

Could hCG levels signify whether you may be having a boy or a girl? A recent study says there is some evidence to support this idea.


hCG Levels and Sex of the Fetus

Q:&nbsp;How can I tell if I am pregnant? Can cervical changes signify that I am pregnant? What about the position of my uterus?
A: There are certain cervical changes that take place during your fertile days. However, there is no clear position of the uterus during very early pregnancy. The uterus can be high or low and the cervix can be soft or firm. The truth is that other than a positive pregnancy test there is no reliable enough sign of an early pregnancy that can give definite proof.

How can I tell if I am pregnant? Can cervical changes signify that I am pregnant? What about the position of my uterus?

Can Uterine Or Cervical Changes Show That I Am Pregnant?

<h2>Q: I am 18 days post ovulation (DPO) and my serum hCG is 556. Could this mean I am having twins?</h2>
A serum hCG of 556 mIU/mL at 18 days post ovulation (DPO) is normal both for one or two fetuses. You could have twins, but you can't really tell from the serum hCG value alone. At 18 DPO the serum hCG for singletons is normally between about 70 and 750 mIU/mL, and for twins, it can be between 200 and about 1750 mIU/ml.

<h2>Are you always carrying twins when hCG increases too fast?</h2>
In most pregnancies, the normal hCG rise is at least 60% over 48 hours. In twins, it may rise much more, but it's not possible to diagnose a twin pregnancy just from the hCG levels alone. The hCG can rise manyfold even without twins.
<h2>How does hCG normally increase?</h2>
<ol>
<li>In most normal pregnancies at hCG levels below 1,200 mIU/ml, the hCG level usually doubles every 48-72 hours, and it normally increases by at least 60% every two days.</li>
<li>In early pregnancy, a 48-hour increase of hCG by 35% can still be considered normal.</li>
<li>As your pregnancy progresses, the hCG level increase slows down significantly.</li>
<li>Between 1,200 and 6,000 mIU/ml serum, the hCG level usually takes 72-96 hours to double.</li>
<li>Above 6,000 mIU/ml, the hCG levels often take over four or more days to double.</li>
<li>In general, when the hCG level reaches 7200 mIU/ml, a yolk sac should be seen.</li>
<li>At an hCG level greater than 10,800 mIU/ml, there should be a visible embryo with a heartbeat.</li>
</ol>

There is no sufficient scientific evidence that with twins there is always a faster-than-usual rise in hCG. Normal hCG values can vary up to 20 times in normal pregnancies. Variations in hCG increases are not necessarily a sign that the pregnancy is abnormal or that there are two or more fetuses.&nbsp;
<h2>Chart showing average&nbsp;serum hCG levels for twins and singletons&nbsp;</h2>
<table style="width: 303px; height: 331px;" border="0" cellspacing="0" cellpadding="0"> <colgroup><col span="3" width="87"> </colgroup>
<tbody>
<tr>
<td class="xl63" style="text-align: center;" width="87" height="21">&nbsp;</td>
<td class="xl64" style="text-align: center;" width="87">Twins</td>
<td class="xl64" style="text-align: center;" width="87">Single</td>
</tr>
<tr>
<td class="xl64" style="text-align: center;" height="21">DPO</td>
<td class="xl64" style="text-align: center;">Average (mIU/ml)</td>
<td class="xl64" style="text-align: center;">Average&nbsp;(mIU/ml)</td>
</tr>
<tr>
<td class="xl63" style="text-align: center;" align="right" height="21">14</td>
<td class="xl63" style="text-align: center;" align="right">68</td>
<td class="xl63" style="text-align: center;" align="right">48</td>
</tr>
<tr>
<td class="xl63" style="text-align: center;" align="right" height="21">15</td>
<td class="xl63" style="text-align: center;" align="right">88</td>
<td class="xl63" style="text-align: center;" align="right">59</td>
</tr>
<tr>
<td class="xl63" style="text-align: center;" align="right" height="21">16</td>
<td class="xl63" style="text-align: center;" align="right">146</td>
<td class="xl63" style="text-align: center;" align="right">95</td>
</tr>
<tr>
<td class="xl63" style="text-align: center;" align="right" height="21">17</td>
<td class="xl63" style="text-align: center;" align="right">154</td>
<td class="xl63" style="text-align: center;" align="right">132</td>
</tr>
<tr>
<td class="xl63" style="text-align: center;" align="right" height="21">18</td>
<td class="xl63" style="text-align: center;" align="right">360</td>
<td class="xl63" style="text-align: center;" align="right">292</td>
</tr>
<tr>
<td class="xl63" style="text-align: center;" align="right" height="21">19</td>
<td class="xl63" style="text-align: center;" align="right">499</td>
<td class="xl63" style="text-align: center;" align="right">303</td>
</tr>
<tr>
<td class="xl63" style="text-align: center;" align="right" height="21">21</td>
<td class="xl63" style="text-align: center;" align="right">963</td>
<td class="xl63" style="text-align: center;" align="right">1061</td>
</tr>
</tbody>
</table>
Read more: <a title="hCG levels and hcg levels chart by week" href="/normal-hcg-blood-level-by-week-during-pregnancy">hCG Levels by Week </a><a href="/normal-hcg-blood-level-by-week-during-pregnancy">Normal hCG Levels In Early Pregnancy </a><a href="/tools/hcg-calculator">hCG Levels Chart And Calculator</a>

Does a fast rising hCG level always indicate that you are carrying twins? What else do hCG levels signify? Could it be twins or is there really just one baby in there? 

Twins and hCG Levels

Q: Are there any side effects of FertilAid?
<a name="effects"></a>A: FertilAid for Women has no known side effects. However, as with any dietary supplement, if you have a pre-existing medical condition, we recommend that you discuss taking FertilAid with your doctor.&nbsp;
The scientifically-validated herbal-nutritional components of FertilAid for Women have been selected for their roles in promoting reproductive wellness.

The scientifically-validated herbal-nutritional components of FertilAid for Women have been selected for their roles in promoting reproductive wellness. But are there any side effects?

Does FertilAid Have Any Side Effects?

Q:&nbsp;Are there any side effects of FertilAid?
<a name="effects"></a>A:&nbsp;FertilAid&nbsp;for Women has no known side effects. However, as with any dietary supplement, if you have a pre-existing medical condition, we recommend that you discuss taking FertilAid with your doctor.&nbsp;
The scientifically-validated herbal-nutritional components of FertilAid for Women have been selected for their roles in promoting reproductive wellness.

FertilAid Side Effects

Around 11-12 weeks many doctors perform a transvaginal sonogram to measure the fetal neck (nuchal translucency) to assess the risk of Down syndrome. At the same time, a blood test is done (PAPP-A = pregnancy associated plasma protein A) to improve the accuracy of the ultrasound. The results of the ultrasound and the blood test are combined to provide a risk for Down syndrome that can then be correlated with the mother's background risk.

Around 11-12 weeks many doctors perform a transvaginal sonogram to measure the fetal neck (nuchal translucency) to assess the risk of Down syndrome.